不同年龄段反复喘息患儿呼出气一氧化氮水平与哮喘发病风险的关系
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摘要
目的探讨不同年龄段反复喘息患儿呼出气一氧化氮(FeNO)水平与哮喘发病风险的关系,以帮助对反复喘息患儿中哮喘高危儿童的筛检。方法选取100例反复喘息患儿为病例组,60例门诊健康体检儿童为健康对照组。采用纳库仑一氧化氮分析仪检测FeNO,同时计算外周血嗜酸性粒细胞计数、哮喘预测指数(API),比较FeNO水平、嗜酸性粒细胞计数、API等在幼儿期和学龄前期喘息患儿之间的差异性。结果幼儿期组和学龄前期组的外周血嗜酸性粒细胞计数、FeNO检测值和阳性检出率高于同年龄段健康对照组,差异有统计学意义(均P<0.05);但幼儿期组和学龄前期组两组的嗜酸性粒细胞计数比较,差异无统计学意义(P>0.05),而学龄前期组FeNO水平、FeNO阳性检出率和API阳性率高于幼儿期组,差异有统计学意义(均P<0.05)。API阳性反复喘息患儿的FeNO水平高于API阴性反复喘息患儿,差异有统计学意义(P<0.05)。学龄前期组FeNO阳性患儿中的API阳性检出率高于幼儿期FeNO阳性患儿,差异有统计学意义(P<0.05)。结论学龄前期反复喘息患儿较幼儿期患儿有更高的哮喘罹患风险,FeNO测定可作为一项早期筛检学龄前期反复喘息患儿中哮喘高危儿童的良好临床指标,值得临床推广应用。
Objective To investigate the relationship between exhaled nitric oxide(FeNO) levels and risks of asthma in children with recurrent wheezing at different ages, to help screen the children with high asthma risk from the children with recurrent wheezing.Methods One hundred children with recurrent wheezing were selected as the case group, and 60 healthy children were selected as healthy control group. All selected children were given the levels of FeNO, and calculated the counts of peripheral blood eosinophil cell and the Asthma Predictive Index(API). The differences of the FeNO levels and eosinophil cell counts and API were compared between early childhood children and preschool children with recurrent wheezing.Results The counts of peripheral blood eosinophil cell and FeNO test value and the positive rate of FeNO of the early childhood group and the pre-school group were higher than those in the healthy control group at same age, and the differences were statistically significant( all P<0.05). However, there was no statistical difference of the eosinophil counts between the early childhood group and the pre-school group(P>0.05). The FeNO leves and FeNO positive rates and API positive rates of the pre-school group were higher than those of the early childhood group, and the differences were statistically significant(all P<0.05). The FeNO test value of children with positive API and recurrent wheezing was higher than that of children with negative API, and the difference was statistically significant(P<0.05). In addition, the positive rate of API in the children with positive FeNO and wheezing in preschool group was significantly higher than that of the infants with positive FeNO and wheezing, and the difference was statistically significant(P<0.05).Conclusion The risk of developing asthma in preschool children with recurrent wheezing is higher than that of early childhood children. The FeNO determination can be used as a good clinical index of early screening of the children with high asthma risk from preschool children with recurrent wheezing, and it's worth recommending in clinical.
Objective To investigate the relationship between exhaled nitric oxide(FeNO) levels and risks of asthma in children with recurrent wheezing at different ages, to help screen the children with high asthma risk from the children with recurrent wheezing.Methods One hundred children with recurrent wheezing were selected as the case group, and 60 healthy children were selected as healthy control group. All selected children were given the levels of FeNO, and calculated the counts of peripheral blood eosinophil cell and the Asthma Predictive Index(API). The differences of the FeNO levels and eosinophil cell counts and API were compared between early childhood children and preschool children with recurrent wheezing.Results The counts of peripheral blood eosinophil cell and FeNO test value and the positive rate of FeNO of the early childhood group and the pre-school group were higher than those in the healthy control group at same age, and the differences were statistically significant( all P<0.05). However, there was no statistical difference of the eosinophil counts between the early childhood group and the pre-school group(P>0.05). The FeNO leves and FeNO positive rates and API positive rates of the pre-school group were higher than those of the early childhood group, and the differences were statistically significant(all P<0.05). The FeNO test value of children with positive API and recurrent wheezing was higher than that of children with negative API, and the difference was statistically significant(P<0.05). In addition, the positive rate of API in the children with positive FeNO and wheezing in preschool group was significantly higher than that of the infants with positive FeNO and wheezing, and the difference was statistically significant(P<0.05).Conclusion The risk of developing asthma in preschool children with recurrent wheezing is higher than that of early childhood children. The FeNO determination can be used as a good clinical index of early screening of the children with high asthma risk from preschool children with recurrent wheezing, and it's worth recommending in clinical.
引文
[1] BEIGELMAN A,BACHARIER L B.Management of preschool recurrent wheezing and asthma:a phenotype-based approach[J].Curr Opin Allergy Clin Immunol,2017,17(2):131-138.
[2] BEIGELMAN A,BACHARIER L B.Management of Preschool Children with Recurrent Wheezing:Lessons from the NHLBI's Asthma Research Networks[J].J Allergy Clin Immunol Pract,2016,4(1):1-8.
[3] CARRARO S,BOZZETTO S,GIORDANO G,et al.Wheezing preschool children with early-onset asthma reveal a specific metabolomic profile[J].Pediatr Allergy Immunol,2018,29 (4):375-382.
[4] Matsunaga K.The latest information on respiratory disease management.topics:i.exhaled nitric oxide measurement:a new diagnostic tool for asthma[J].Nihon Naika Gakkai Zasshi,2016,105(6):950-956.
[5] 中华医学会儿科学分会呼吸学组.儿科支气管哮喘诊断与防治指南[J].中华儿科杂志,2008,46(10):745-753.
[6] BJERMER L,ALVING K,DIAMANT Z,et al.Current evidence and future research needs for FeNO measurement in respiratory diseases[J].Respir Med,2014,108(6):830-841.
[7] CASTRO-RODRIGUEZ J A.The Asthma Predictive Index:A very useful toolfor predicting asthma in young children[J].Allergy Clin Immunol,2010,126(2):212-216.
[8] MICHELLE F H,WANDA P.Utility of the Asthma Predictive Index in predicting childhood asthma and identifying disease-modifying interventions[J].Ann Allergy Asthma Immunol,2014,112(3):188-190.
[9] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016 年版)[J].中华儿科杂志,2016,54(3):167-181.
[10] LAURA T,MICHELE P,GIORGIO P.Recurrent wheezing in children[J].Transl Pediatr,2016,5(1):31-36.
[11] ESPOSITO S,GALEONE C,LELII M,et al.Impact of air pollution on Respiratory diseases in children with recurrent wheezing or asthma[J].BMC Pulm Med,2014,14(7):130.
[12] AVRAHAM B,LEONARD B.Bacharier.Management of preschool children with recurrent wheezing:lessons from the NHLBI’s asthma research networks[J].Allergy Clin Immunol Pract,2016,4(1):1-8.
[13] DEL ROSAL T,GARCíA-GARCíA M L,CALVO C,et al.Recurrent wheezing and asthma after bocavirus bronchiolitis[J].Allergol Immunopathol(Madr),2016,44(5):410-414.
[14] MORALES M,FLORES C,PINO K,et al.Urinary leukotriene and Bcl I polymorphism of glucocorticoid receptor gene in preschoolers with recurrent wheezing and high risk of asthma[J].Allergol Immunopathol (Madr),2016,44(1):59-65.
[15] LUCIANA A,VIRGINIA P L,ATAIDE C.Role of the asthma predictive index (API) in assessing the development of asthma among Brazilian children[J].World Allergy Organ,2015,8(l1):A61.
[16] 李硕,刘传合,宋欣,等.肺功能测定支气管舒张试验对婴幼儿哮喘诊断的价值[J].实用儿科临床杂志,2007,22(19):1475-1476.
[17] ANTONIUS S,GUDRUN W,RUDOLF A J,et al.Influence of the practice setting on diagnostic prediction rules using FENO measurement in combination with clinical signs and symptoms of asthma[J].BMJ Open,2015,5(11):e009676.
[18] RICCIARDOLO F L,SORBELLO V,CIPRANDI G.FeNO as biomarker for asthma phenotyping and management[J].Allergy Asthma Proc,2015,36(1):1-8.
[19] DWEIK R A,BOGGS P B,ERZURUM S C,et al.An official ATS clinical practice guideline:interpretation of exhaled nitric oxide levels (FENO) for clinical applications[J].Respir Crit Care Med,2011,184(5):602-615.
[20] 温志红,杨英杰,王美春,等.婴幼儿喘息患儿呼出气一氧化氮的变化及临床意义[J].中国临床新医学,2017,10(4):303-305.
[21] 陈进喜,白珺,刘志刚,等.反复喘息儿童体外过敏原检测及临床意义分析[J].临床医药杂志,2014,18(3):133-l35.
[22] 沙莉,邵明军,刘传合,等.2010年与2000年中国城市儿童支气管哮喘患病率比较[J].中华结核和呼吸杂志,2015,38(9):664-668.
[23] 王梦娟,刘长山,王雪艳,等.离线法呼出气一氧化氮测定在儿童哮喘早期预测中的应用价值[J].中国全科医学,2016,19(22):2666-2670.
[24] ARNOLD R J,MASSANARI M,LEE T A,et al.A Review of the Utility and Cost Effectiveness of Monitoring Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management[J].Manag Care,2018,7(7):34-41.
[2] BEIGELMAN A,BACHARIER L B.Management of Preschool Children with Recurrent Wheezing:Lessons from the NHLBI's Asthma Research Networks[J].J Allergy Clin Immunol Pract,2016,4(1):1-8.
[3] CARRARO S,BOZZETTO S,GIORDANO G,et al.Wheezing preschool children with early-onset asthma reveal a specific metabolomic profile[J].Pediatr Allergy Immunol,2018,29 (4):375-382.
[4] Matsunaga K.The latest information on respiratory disease management.topics:i.exhaled nitric oxide measurement:a new diagnostic tool for asthma[J].Nihon Naika Gakkai Zasshi,2016,105(6):950-956.
[5] 中华医学会儿科学分会呼吸学组.儿科支气管哮喘诊断与防治指南[J].中华儿科杂志,2008,46(10):745-753.
[6] BJERMER L,ALVING K,DIAMANT Z,et al.Current evidence and future research needs for FeNO measurement in respiratory diseases[J].Respir Med,2014,108(6):830-841.
[7] CASTRO-RODRIGUEZ J A.The Asthma Predictive Index:A very useful toolfor predicting asthma in young children[J].Allergy Clin Immunol,2010,126(2):212-216.
[8] MICHELLE F H,WANDA P.Utility of the Asthma Predictive Index in predicting childhood asthma and identifying disease-modifying interventions[J].Ann Allergy Asthma Immunol,2014,112(3):188-190.
[9] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016 年版)[J].中华儿科杂志,2016,54(3):167-181.
[10] LAURA T,MICHELE P,GIORGIO P.Recurrent wheezing in children[J].Transl Pediatr,2016,5(1):31-36.
[11] ESPOSITO S,GALEONE C,LELII M,et al.Impact of air pollution on Respiratory diseases in children with recurrent wheezing or asthma[J].BMC Pulm Med,2014,14(7):130.
[12] AVRAHAM B,LEONARD B.Bacharier.Management of preschool children with recurrent wheezing:lessons from the NHLBI’s asthma research networks[J].Allergy Clin Immunol Pract,2016,4(1):1-8.
[13] DEL ROSAL T,GARCíA-GARCíA M L,CALVO C,et al.Recurrent wheezing and asthma after bocavirus bronchiolitis[J].Allergol Immunopathol(Madr),2016,44(5):410-414.
[14] MORALES M,FLORES C,PINO K,et al.Urinary leukotriene and Bcl I polymorphism of glucocorticoid receptor gene in preschoolers with recurrent wheezing and high risk of asthma[J].Allergol Immunopathol (Madr),2016,44(1):59-65.
[15] LUCIANA A,VIRGINIA P L,ATAIDE C.Role of the asthma predictive index (API) in assessing the development of asthma among Brazilian children[J].World Allergy Organ,2015,8(l1):A61.
[16] 李硕,刘传合,宋欣,等.肺功能测定支气管舒张试验对婴幼儿哮喘诊断的价值[J].实用儿科临床杂志,2007,22(19):1475-1476.
[17] ANTONIUS S,GUDRUN W,RUDOLF A J,et al.Influence of the practice setting on diagnostic prediction rules using FENO measurement in combination with clinical signs and symptoms of asthma[J].BMJ Open,2015,5(11):e009676.
[18] RICCIARDOLO F L,SORBELLO V,CIPRANDI G.FeNO as biomarker for asthma phenotyping and management[J].Allergy Asthma Proc,2015,36(1):1-8.
[19] DWEIK R A,BOGGS P B,ERZURUM S C,et al.An official ATS clinical practice guideline:interpretation of exhaled nitric oxide levels (FENO) for clinical applications[J].Respir Crit Care Med,2011,184(5):602-615.
[20] 温志红,杨英杰,王美春,等.婴幼儿喘息患儿呼出气一氧化氮的变化及临床意义[J].中国临床新医学,2017,10(4):303-305.
[21] 陈进喜,白珺,刘志刚,等.反复喘息儿童体外过敏原检测及临床意义分析[J].临床医药杂志,2014,18(3):133-l35.
[22] 沙莉,邵明军,刘传合,等.2010年与2000年中国城市儿童支气管哮喘患病率比较[J].中华结核和呼吸杂志,2015,38(9):664-668.
[23] 王梦娟,刘长山,王雪艳,等.离线法呼出气一氧化氮测定在儿童哮喘早期预测中的应用价值[J].中国全科医学,2016,19(22):2666-2670.
[24] ARNOLD R J,MASSANARI M,LEE T A,et al.A Review of the Utility and Cost Effectiveness of Monitoring Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management[J].Manag Care,2018,7(7):34-41.